We'll come to order, please.
Welcome, everyone. We're very grateful today as always to be meeting on unceded Algonquin territory.
I just want to take one minute for some housekeeping, and then we'll get right into the session with our guests.
First, I want to say welcome back to David Yurdiga who's been doing yeoman service in Fort McMurray for the past several weeks, helping his community there. David, well done. It's nice to have you here.
I'd like to introduce the committee to Grant McLaughlin, who is joining us right now as a clerk for a while. You'll be seeing his face around, and we welcome Grant as well.
With regard to the suicide study, if you still have witness names you'd like to add to that list, I'm reminding you of the June 15 deadline for additional witnesses so that the analysts can plan the logistics of that trip and that study.
Then finally, you may recall at our last meeting we talked about having each member indicate which of the communities we're visiting are mandatory for them and which would be nice to have.
Michelle Legault, as our clerk, has kindly prepared a little form. It's easy to fill in. You check boxes. I'm going to ask Michelle to pass that around. Perhaps you or the staff members that are with you might get that done while we are here today. That would be great, but if not, certainly if we could have that completed form back for Thursday's meeting this week, that would allow us to build a budget and proceed with the study.
Thank you very much for that. Let's go right in.
We're very happy to have some guests from Indigenous and Northern Affairs Canada. We welcome Paula Isaak, the assistant deputy minister, education and social development programs and partnerships; and Daniel Leclair, director general of the community infrastructure branch, regional operations. From Health Canada, Keith Conn is with us. He is the assistant deputy minister of regional operations. Dr. Tom Wong is here again, executive director, office of population and public health. From the Canadian Institutes of Health Research, we have Dr. Alain Beaudet, the president.
Welcome to you all.
Since we have this group for the full two hours, I wonder if we might give our speakers 15 minutes rather than the usual 10. Is there consent among the committee members for that?
To begin, I would like to acknowledge that we are on the traditional territory of the Algonquin people. Thank you for gathering us here today and inviting us to speak on this very important issue of suicide in indigenous communities in Canada.
As a physician and as a father, I know the death of a child is heartbreaking. A death of a 10-year-old child by suicide compounds that heartbreak as the profound impacts spread across families and communities. The circumstances are tragic and difficult to comprehend. When we ask ourselves why, we must acknowledge the impacts of colonization, which continue to affect indigenous peoples today. The Truth and Reconciliation Commission has offered Canada the knowledge and recognition that policies of forced assimilation have assaulted and suppressed indigenous culture for as long as Canada has existed as a nation.
As a nation, we now have an opportunity to recognize that the introduction of the reserve era in the 19th century, the residential school experience in the 20th century, and the forced adoption policies of the sixties and the seventies are just examples of policy that led to eradication of culture, loss of language, erosion of traditional values, and the disintegration of traditional family structures. These impacts have been passed down through the generations and these effects are often referred to as intergenerational trauma and have led to the tragedies that we collectively face today.
Health Canada, through the first nations and Inuit health branch, recognizes the need to reset its relationship with indigenous partners, and through these relationships, support community-led, comprehensive, culturally founded, and culturally safe services that are integrated into a broader continuum of wellness programming.
My role and the work of the branch is guided by inclusive and participatory policy engagement approaches with first nations and Inuit organizations, as seen through several key frameworks developed in partnership with indigenous organizations.
In fulfilling the mandate to promote the health of indigenous peoples, I advocate for equitable programming to address social determinants of health, and to strengthen prevention, diagnosis, treatment, support, surveillance, and data for public health actions.
In Canada, the rates of indigenous suicide are much higher than the general population. The overall Canadian rate has declined, while in some aboriginal communities rates have continued to rise. In general, risk factors for suicide include depression, hopelessness, low self-esteem, substance use, suicide of a family member or friend, a history of physical or sexual abuse, family violence, intergenerational trauma, poor peer relationships, social isolation, poor performance in school, and unemployment, to name just a few.
Protective factors that contribute to resilience include family cohesion, good communication, feeling understood by one's family, involvement in family and community activities, indigenous language, cultural knowledge, activities with elders and traditional healers, community self-determination, good peer relations, and school successes.
Suicide is just one indicator of distress in communities. For every suicide there may be many more people suffering from depression, anxiety, and despair.
There are five key elements funded by Health Canada to support first nations and Inuit health: health promotion, health protection, primary care services, supplemental health benefits, and health infrastructure support. Health Canada spends $300 million a year in community-based programming and services guided by mental wellness frameworks. Through a variety of targeted programs, organizations and communities deliver mental health promotion, addictions and suicide prevention, crisis response services, treatment and aftercare, including prescription drug abuse and supports for eligible former students of Indian residential schools and their families.
Mental wellness teams are community-led teams that provide a comprehensive suite of culturally appropriate services, which include but are not limited to capacity-building, trauma-informed care, land-based activities, early intervention and screening, aftercare, and care coordination with provincial and territorial services. Each mental wellness team serves between two and 10 communities, depending on community size, location, and need. Health Canada has allocated funding to regions for 10 mental wellness teams. The B.C. First Nations Health Authority also funds a team in B.C. However, flexible funding allows regions to maximize the number and reach of teams to address regional needs.
The brighter futures, building healthy communities program, available to all first nations and Inuit communities, supports improved mental health, child development, parenting skills, healthy babies, injury prevention, and response to mental health crisis, depending on community needs.
The IRS resolution health support program provides cultural, paraprofessional, and professional supports to eligible former students, their families, and communities.
The national native alcohol and drug abuse program and the national youth solvent abuse program include funding for 43 first nations addiction treatment centres and community-based prevention programs that respond to substance abuse.
The national aboriginal youth suicide prevention strategy supports over 130 community-based suicide prevention projects in first nations and Inuit communities across Canada. Strategy funding was used to train over 800 community-based front-line workers to provide culturally appropriate information about suicide prevention. We have seen positive results.
For example, the Taiga Adventure Camp is a camp for girls aged 11 to 17 and is open to all 33 Northwest Territories communities. The goal of the camp is to increase self-esteem and promote healthy living, relationships, and mental wellness to protect against youth suicide. The camp uses outdoor skills development to provide leadership opportunities and develop confidence and respect for others. Outcomes have shown improvements in confidence, initiative, leadership, and optimism, an increased ability to address conflict, and improved knowledge of protective factors.
The department is also supporting the development of a web-based first nations “wise practices” resource that will allow communities to access and implement proven and promising youth suicide prevention strategies.
The Mental Health Commission of Canada has been provided with $1.2 million from FNIHB to support first nations and Inuit adaptation of its mental health first aid training.
Health Canada, the Assembly of First Nations, and community mental health leaders jointly developed a first nations mental wellness continuum framework, grounded in culture as its foundation.
Application of the framework is supported by an implementation team with members across regions and communities, as well as the department.
FNIHB is also supporting ITK in their work to develop Inuit mental wellness teamwork and an Inuit suicide prevention strategy. Both the strategy and the framework are anticipated to be finalized later on in 2016.
Other federal programs and departments, including but not limited to INAC, Public Health Agency of Canada, CIHR, Public Safety, and Justice provide programs and services to first nations that address indigenous social determinants of health, and they are important partners in this effort.
Health Canada is working with partners on their approach based on mental wellness frameworks that amalgamate mental wellness programming and seek additional resources to address gaps. Additional resources are required to expand core services and services that help indigenous people, and any new federal funding will support the long-term goal of transfer to communities, alignment, and integration with provincial services. Promising practices of community healing relate to culture and identity, and are community-based, community-paced, and community-led initiatives with strength-based and holistic approaches that blend western and indigenous therapeutic approaches with strong community relationships.
While important progress has been made, it is clear that more needs to be done. The levels of health inequity between indigenous Canadians and the rest of Canada are unacceptable. Health Canada will continue to work with first nations and Inuit to advance areas of mutual priority. Efforts to support first nations and Inuit in their aim to influence, manage, and control health programs and services that affect them continue to be fundamental for improving health outcomes and access to needed health services and programming.
In addition, Health Canada will participate in a whole-of-government approach to address the recommendations of the Truth and Reconciliation Commission, but this is not something we do alone. Reconciliation is the work of Canada as a whole. I ask you to join us in the efforts of reconciliation and ensure that all children in Canada have access to nutritious food, safe housing, quality education, clean water, and finally, access to a robust and responsive health system.
Mr. Chair, I'm glad we had the opportunity to present here today on this very important issue. My colleagues and I would be pleased to respond to the committee's questions at the end of all the opening remarks. Thank you.
First I would like to thank the committee as well for inviting me to discuss this critical issue of suicide prevention in first nations, Inuit, and Métis communities. As president of the Canadian Institutes of Health Research, or CIHR, I appreciate the opportunity to share with your committee the vital role that research is playing to address this tragedy.
As you may be aware, CIHR is the Government of Canada's granting agency responsible for supporting health research in universities, hospitals, research centres, and communities across Canada. CIHR's commitment to address the disproportionate health burden faced by indigenous people in Canada is steadfast. This is why we have made the health and wellness of indigenous communities and families one of four research priorities in our most recent five-year strategic plan.
When it comes to suicide, science has a critical role to play in helping us understand the root causes of this most complex and sensitive issue, and in developing evidence-based solutions for preventing it. The causes behind the unacceptably high incidence of suicide among indigenous people and how to design and evaluate interventions aimed at promoting mental wellness are at the heart of our research efforts.
It is important to understand that the research funded by CIHR on the topic of suicide and mental health covers a vast range of the health sciences, from basic to applied. It ranges from studies on the biological basis of depression to investigations of the cultural, social, and environmental risk factors linked to suicide ideation.
It includes, for example, research on the effects of the environment on genetic disposition to mental health disorders, research on intergenerational health impacts of residential schools, studies linking suicide to variance in exposure to daylight in the north, and the psychosocial impacts of housing conditions.
The research is happening at all levels, for it is critical to understand the etiology and the risk factors underpinning these high suicide rates if we want to be in a position to meaningfully address and prevent them. Indeed, research on suicide is not only meant to improve our understanding of the problem, but it is also meant to help develop evidence-informed interventions and programs, in other words, to translate knowledge into practice.
Appropriate interventions can be successful, as demonstrated by Quebec's preventative efforts, which led to a more than 50% reduction in suicide rates among its youth; this reduction was even more pronounced among young men.
It is imperative that research be leveraged in a similar way to help address suicide in first nations, Inuit, and Métis communities. We are talking about two very different sets of research questions and approaches here. The first, referred to as intervention or comparative effectiveness research, is about developing and testing the efficiency of interventions under tightly controlled conditions. The second, referred to as implementation research and delivery science, or IRDS, is about implementing and scaling up successful interventions in the real world. What works, for whom, and in which circumstances? How can successful prevention strategies be adapted and scaled up for different communities and settings?
Implementation science needs that research to be embedded into care and adapted to socioeconomic and cultural contexts to maximize efficiency and impact.
Implementation science and delivery research is a relatively new area of health research that we have embraced at CIHR to address a number of global health issues, including indigenous people's health. Thus, through a major strategic research initiative called “Pathways to Health Equity for Aboriginal Peoples”, we have supported a series of implementation science projects aimed at improving mental wellness and reducing the incidence of suicide in indigenous communities.
For instance, a project led by Dr. Claire Crooks from the Centre for Addiction and Mental Health in Toronto, took the mental health first aid program and adapted it to first nations communities across Canada. This original program had been demonstrated to increase individual skills and knowledge about how to respond in a mental health crisis.
It is currently used across Canada; however, previous evaluation studies found a critical need to culturally adapt the program to first nations communities. Using a combination of interviews, focus groups, implementation tracking, and surveys, the research studied the implementation of the adapted program in several first nations communities and confirmed its effectiveness.
Another example of the CIHR-funded research aimed at implementing research into practice is ACCESS open minds, a groundbreaking, national research network focused on youth mental health. Through this network, supported in partnership with the Graham Boeckh Foundation, researchers are taking existing mental health practices and treatments and making them age-appropriate for diverse youth populations. Through testing and evaluation of these tailored youth interventions at 12 sites across the country, including five that are working with indigenous communities, this network will help identify effective approaches for assessing and treating Canadian youth with mental illnesses.
A common feature of these two research initiatives is that they both involve multiple research sites and allow for learning across communities and between jurisdictions. Crossing jurisdictional boundaries also means developing international collaborations to address suicide prevention. The issue of indigenous suicide is not unique to Canada. Indigenous populations in other countries such as the U.S., Denmark, Sweden, and Australia are facing similar challenges.
While some of the causes and manifestations of suicide differ across countries, as they do across Canada's first nations, Inuit, and Métis communities, there are also important points of commonality and overlap. This shared problem presents an opportunity for joint research efforts and the sharing of best practices across borders. This is why since 2013 we've been involved in international research efforts to address suicide prevention in northern indigenous communities through the Arctic Council. Under the Canadian chairmanship of this international forum during 2013-15, CIHR spearheaded a research initiative involving researchers and community members from across four Arctic countries to identify promising practices in suicide prevention. These efforts culminated in an Arctic symposium in Iqaluit, held in March 2015, where researchers shared best practices in suicide prevention. The symposium was hosted jointly by the CIHR, the Government of Nunavut, and international partners.
As a second phase of this work, we are now partnering with a U.S. organization, the National Institutes of Health, in a follow-up project to further address suicide in Arctic regions. Through this follow-up initiative, called the RISING SUN, partners from across the Arctic states are coming together to identify common metrics to track suicidal behaviours, as well as key correlates and outcomes, so as to facilitate data sharing, evaluation, and interpretation of interventions for suicide prevention.
CIHR will soon be launching another major international research program on global mental health through the Global Alliance for Chronic Diseases or GACD, an international consortium of health research funders that Canada currently chairs. This program, with a combined international investment of over $60 million, will fund research into the prevention and management of mental disorders, with a focus on interventions in low- and middle-income countries, as well as vulnerable populations in high-income countries, including Canada's indigenous populations. Once again, through this opportunity, the CIHR will be able to leverage knowledge from international contexts that are relevant for Canada and will provide tools to tackle the issue of suicide in our communities.
These are just a few national and international examples of how CIHR is supporting research to address wellness and suicide prevention in indigenous communities. Through the science and applied research initiatives I described, CIHR is committed to continue supporting research to identify ways to promote resilience and positive mental health among indigenous peoples and to ensuring that research evidence is brought to bear on policy-making through knowledge translation.
In this regard, CIHR will look forward to continue working with Health Canada and other federal, provincial, and territorial partners to help inform policies and programs related to indigenous health.
Before closing, I would like to take a moment to underscore that all of the CIHR research projects in this area are designed and carried out in close collaboration with indigenous communities. Our ultimate objective over the long term is to develop and support a cadre of indigenous researchers as they are best positioned to understand from the inside the cultural determinants of mental wellness.
This is why strengthening research capacity within our indigenous population is at the heart of the CIHR agenda.
Finally, please allow me to acknowledge that research is only part of the solution to this very complex and challenging issue, but it is an important one for identifying the most effective path to achieving wellness.
Mr. Chair, thank you again for this opportunity to share our work with you in this critical area. I look forward to your questions.
Good afternoon, Mr. Chairman and members of the committee.
I'd like to thank the committee for this invitation and would also like to acknowledge that we are gathered on traditional Algonquin territory. This is an important study, and I want to offer INAC's full support as it evolves.
As my colleagues have noted, suicide is often the tragic consequence of a complex array of factors.
That includes mental health issues such as depression, substance abuse, social and family factors, poor performance in school, and bullying or relationship issues.
One of the contributing factors to high suicide rates among first nations and Inuit, including youth, is inadequate basic supports. These can include a lack of income supports, education opportunities, adequate housing, or health and social services. These factors of instability have direct repercussions on the decline of mental health in indigenous communities, and each element is part of a continuum that is vital to providing a sense of hope, to wanting to go on in life, and to seeing oneself contributing in society.
I understand that, among other aspects, the committee will be studying these risk factors broadly, as well as protective factors that promote well-being and help reduce vulnerability.
This broad approach is helpful because so many players are involved in ensuring that those basic needs for indigenous communities are met.
For my part, I'll frame my remarks around those elements today, in order to best provide context on INAC's roles and programs. INAC, as you know, is a focal point at the federal level for indigenous issues. We are one of 34 federal departments responsible for meeting the Government of Canada's obligations and commitments to first nations, Inuit, and Métis.
INAC provides financial support to first nations communities to deliver services on reserve. This includes education, housing, and social support to indigenous peoples.
Our social programs aim to assist first nation individuals and communities to become more self-sufficient, and promote strategies to reduce the risk factors that negatively affect the health and well-being of communities.
Embedded in many of these programs is funding for prevention. It supports indigenous families and communities in taking steps to avoid situations of crisis, and in achieving improved outcomes whether they be in the care of children or generally in the support for greater participation in the labour market.
The department flows funds to first nation bands, organizations, and, in some cases, provincial service providers who provide on-reserve residents with individual and family social services that aim to offer culturally appropriate programming to meet the needs of those individuals and families.
INAC also provides funding for a suite of elementary and secondary programming through core funding and complementary targeted request- and proposal-based education programs that seek to focus on specific aspects of education support and success.
INAC's elementary and secondary education program funding is part of a broader strategy of investment in first nations children and youth. In addition to supporting elementary and secondary education, INAC also provides support to first nation and Inuit students to attend post-secondary institutions. Health Canada and the Public Health Agency of Canada provide early childhood programs such as the aboriginal head start program, which helps promote school readiness among aboriginal children. Employment and Social Development Canada has labour market programs tailored specifically to aboriginal Canadians, including the first nations job fund and the aboriginal skills and employment training strategy. Departments are increasingly looking for ways to enhance co-operation.
In all cases, the programs are intended to be community-driven.
These types of programs go a long way toward promoting stronger, healthier communities, and toward reducing vulnerability and improving mental well-being.
The fundamental challenge that's before all of us is improving the foundations upon which indigenous communities can thrive. When those basic needs are not met, it is a tragic reality that crises and emergencies can occur. In those cases, as the committee knows, both our minister and departmental officials engage quickly with local leaders to discuss how best to give immediate and long-term help.
Certainly this outreach informs our ongoing efforts on how to proceed to meet the Government of Canada's commitment to working on a nation-to-nation basis and improving health and social outcomes in first nation communities, identifying program supports for required services, and strengthening the resilience among children and families on reserve.
In all cases, collaboration between all partners is key in working toward ensuring the continuum is working—that basic needs are in place to not only address crises when they occur, but more importantly prevent them from happening in the first place.
As part of historic budget 2016's $8.4 billion in investments, the department is on track to providing first nation recipients with the first round of investments. Much of this early budget funding is earmarked for addressing basic needs. As that moves forward, INAC remains committed to delivering on the government's promise of a new fiscal relationship with first nations to provide sufficient, predictable, and sustained funding for first nations communities.
I can also report that the continues to work with cabinet colleagues on several early key initiatives, as outlined in their respective mandate letters.
This includes elementary and secondary education, the first nation and Inuit youth employment strategy, and post-secondary education.
Our department's work also contributes to meeting the Government of Canada's commitment in addressing the Canadian Human Rights Tribunal's order to reform the first nations child and family services program. We are also moving with all partners toward meaningful engagement with regard to informing options for program reform.
Recently departmental officials also joined the in announcing full support for the United Nations Declaration on the Rights of Indigenous Peoples. One of the principles of that declaration reads, “Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health.”
The department is committed to working in collaboration with partners to ensure those gaps between indigenous and non-indigenous people are closed, and to help first nations, Inuit, and Métis people improve wellness.
On one front, the department and spent the months from December to February engaging with survivors, families, and loved ones, indigenous organizations and governments, and provinces, territories, and experts on the design of an inquiry into missing and murdered indigenous women and girls. We expect that this inquiry will also shed more light on many of the conditions that lead, tragically, to suicide in some communities.
I will also highlight that the is working with the to launch consultations with provinces and territories and indigenous peoples on a national early learning child care framework. This is a first step towards delivering affordable, suitable, high-quality, flexible, and fully inclusive child care.
A key component of combatting this ongoing tragedy is working in partnership with indigenous communities to promote and ensure that indigenous peoples have a secure personal cultural identity. This is a key issue for the and department. I am sure my colleagues at Health Canada will attest to the evidence that shows that a stronger sense of identity and self-sufficiency can in fact lead to reduced rates of suicide in indigenous communities.
As I and my colleagues have noted, to truly improve the situation for indigenous peoples, we must focus squarely on improving the socioeconomic conditions they face.
We will continue to reach out to provinces, territories, indigenous leadership, and others to find concrete solutions and look at long-term needs in mental health, child welfare, education, infrastructure, and employment in indigenous communities. I look forward to the advice, support, and dedication of this committee as we move the yardstick forward together on these issues.
I will be happy to answer any questions at the end.
Thank you very much.
I'll start with a response, and then my colleagues at INAC perhaps can chime in as well.
Indeed, actually, we do have a number of frameworks and strategies. Those are limited in scope at the moment. For example, we have the national aboriginal youth suicide prevention strategy. That strategy is limited in scope because it only deals with prevention: primary prevention, secondary prevention, and tertiary prevention.
As you said, there are many upstream items that are not covered, such as, education, culture, etc. All of those need to be built onto this pre-existing national aboriginal youth suicide prevention strategy in order to make it a comprehensive strategy, because one cannot go with a health-only approach. One needs to deal with all of the other socio-cultural factors, housing, etc. For that, we are absolutely very interested in working with any sectors who are interested.
On the issue of working with indigenous organizations, we've been working very closely with the AFN, as well as with ITK. We worked with the AFN on co-developing the framework for the first nations suicide prevention and continuum framework. For the Inuit, we work with ITK to assist them in developing their suicide prevention strategy, as well as the mental wellness continuum framework.
We have regular meetings with those organizations, those national organizations, learning from them and offering any assistance we can to them so that together we can actually help address this very complex problem. We have been hearing from our AFN and ITK partners that they are very interested—
I can give you some details on that. It's a program-based government approach that relies on structured prevention policies.
As is always the case when it comes to research, we are in the situation your colleague referred to earlier. We want to find out which policies had an impact and to what extent the impact of those new policies was positive. Can we establish any correlations? Without question, Quebec is currently experiencing a lower suicide rate, and it is holding steady. Year after year, we've seen an absolutely phenomenal drop in Quebec's suicide rate. Which programming elements and which preventative measures were applied, specifically? Establishing the cause-and-effect relationship—not just the correlation—is still a challenge. I would certainly be happy to send you the relevant documentation.
One thing is clear, however, and it was certainly noticeable when we looked at the various interventions used in the U.S., Australia, Greenland, and Canada. To be effective in preventing suicide, the interventions must be heavily adapted to local socioeconomic conditions and local communities and, as my colleague said, rely on community engagement. Of course, youth-focused models are paramount, and they will vary tremendously from one community to another and grow based on the level of remoteness.
Unfortunately, it won't work to simply take Quebec's prevention policies, lock stock and barrel, and apply them to Nunavut. I can't stress enough how important that is to understand.
It's equally important to understand which elements can be imported and how they can be tailored. I gave you the example of a researcher who took prevention programs that had been successful elsewhere and, working hand-in-hand with the communities, adapted them to first nations. These tailored programs have been met with tremendous success. Clearly, that's one solution that is worth a much closer look.